Health Bill

Baroness Manzoor Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

I do not believe this needs to be set out in legislation, but it is necessary to get this clarity as well as the timeline. Regarding the population health improvement plans, how will resources be allocated to ensure that inequalities are addressed and that there will be a joint system with local authorities as well as local stakeholders?

[Baroness Manzoor (Con)]

My Lords, I thank the Minister very much. I am absolutely delighted that the Government have listened with regards to Healthwatch and HSSIB, which are two very important legs of the NHS in terms of independence, patient safety and patient voice. I welcome that and thank the Minister; I know that she is also passionate about those areas.

I thank my noble friend Lord Howe and others who have spoken on his amendment. Irrespective of what one feels about NHS England—I will certainly share my views—it is right that there is an operational plan and a transitional plan. No business would move to such a major reorganisation without having such plans and risk assessments, with key performance indicators and clarity around outcomes in relation to budgets and finance.

My key question is that if savings are to be made, when will they made and how will they be reinvested into direct patient care? With all these changes, what does it mean for the patient? How do they benefit, so that we are not just talking round and round to ourselves about reorganisations?

I have been involved with the NHS for nearly over 40 years—the noble Lord, Lord Hunt, and I have been around a long time. I chaired a health authority when I was in my 20s, and I chaired one of the eight regional offices of the NHS. My region was northern and Yorkshire, and we had a budget of £3.5 billion. I have some experience of transformation and of the difficulties, challenges and risks that will be involved. If we do not have these plans or clarity, things will go wrong. That will adversely affect patient care, when trying to improve patient care is what the Bill is really about.

I do not like to see lots of duplication in services. I like direct and simplified governance structures in the NHS. We had them when we had the regional offices. I recollect—it was a Labour Government at that time—that the eight regional chairs rocked up to the Department of Health, I think quarterly although the memory has faded a bit, and sat down with the Secretary of State, the Permanent Secretaries and the chief executive of the NHS Executive. We went round to find out what the finances were within our regions, which hospitals were performing well and which were not, and where there were real issues about waiting lists. It really concentrated the mind. Then we went back and fed it to all the 60 or 80 chairmen within our regions and their respective chief executives. I am not too worried and concerned that there will be a lot of haters, but we must have very clear plans to enable this to happen.

Last but not least, I want to talk about the governance structures; I mentioned them in my speech previously. If we do not have clarity around governance structures and accountability, we really will not deliver. If there is one plea that I can make, can it be that? I totally support the amendment tabled by my noble friend Lord Howe.

[Baroness Gerada (CB)]

My Lords, one of the people who I have most admired over the years is the American paediatrician, Professor Don Berwick—some of your Lordships may know him—who is an international expert on healthcare and a great advocate of the NHS. In fact, he led the Mid Staffs review in 2013. In the States, he led Medicare and Medicaid under President Obama. It always struck me that Don Berwick wrote us a birthday card on the NHS’s 60th birthday. It was a long card and I urge your Lordships to read it one day. He offered a simple prescription for the NHS: “Stop restructuring”. He warned that successive reorganisations drained the workforce’s “energy and confidence” and argued that stability makes improvement easier. Does the Minister agree that his advice would be well taken?

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[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness, Lady Tyler, and the noble Lord, Lord Patel, made some important points about cross-government working. I was thinking back to what the noble Lord, Lord Patel, said, basically that what started under Tony Blair was continued under Gordon Brown. It was backed up by, first, a specific Cabinet committee, which underpinned the inequalities work, and, secondly, by what were called PSA targets, which tied different departments in. I think that was a good mechanism. In defence of the Government, though, the important work that is being undertaken in relation to health inequality by Alan Milburn, working with different government departments, is going to be pivotal because it embraces the terrible outcomes for so many people who come under the NEET category. It is also looking at the dreadful mental health support for children and adolescents, which goes to the heart of many of these issues. If we can pull this off, we can start to achieve some of the equality issues that we have been talking about.

Like the noble Baroness, Lady Tyler, I am here to say a few words about coastal health because the noble Lord, Lord Patel of Bradford, told us we must. Five years ago, the Chief Medical Officer devoted his 2021 annual report to health in coastal communities. He identified high levels of poor physical and mental health, an ageing population with increasingly complex needs and serious challenges in recruiting and retaining the healthcare workforce. The noble Lord, Lord Patel, basically has three asks, on which I want to reinforce what the noble Baroness, Lady Tyler, said. Five years after the CMO’s report, we have no strategy. First, will the Government publish a substantive account of progress against his recommendations? Secondly, how will the Government ensure that coastal populations are separately identified? Unless we do that, we do not have the data on which to plan and strategise and see whether improvements can be made. Thirdly, will the department work across government to develop and test commissioning prevention workforce models suited to the distinctive geography and needs of coastal communities? I would be very grateful if my noble friend would agree to meet the noble Lord, Lord Patel of Bradford, to discuss this further, because it is an important consideration.

My Amendment 11 relates to the terrible distribution of GPs in England currently and asks for a much more equitable distribution. I am grateful to the noble Baronesses, Lady Gerada, Lady Hodgson and Lady Manzoor, for their support. Last week I was very fortunate to have a meeting with Minister Dame Diana Johnson and her officials, which I found extremely helpful, and I was grateful to her officials for the way they have been prepared to communicate on this.

This morning, the RCGP published the State of General Practice 2026 report. Chapter 4, about fair and sustainable general practice care—equitable care—makes clear that action is needed. One area where I believe we need action is what the noble Lord, Lord Darzi, described as

“huge and unwarranted variations in the number of patients per GP”.

Data from the NHS general practice workforce team shows that the national average list size of fully qualified full-time equivalent GPs hovers at around 2,200 patients. John Gooderham, a retired civil servant who once worked for me, undertook a number-crunching exercise showing that the differences in average list sizes are almost unbelievable. His evidence, which was published by the Institute of Health and Social Care Management, showed at least 20 areas with an average list size ranging from 8,300 to 4,400 patients, almost four times as many as the national average. All of them are clearly severely underdoctored. At the other end of the scale, there are 20 areas with an average list size ranging from 1,000 to 1,444 patients.

The trouble is that there seems to be no approach or system to rectify this. We used to have the Medical Practices Committee, which was set up by Nye Bevan in the 1946 Act and lasted until 2001. I have to confess that I took through the legislation abolishing the MPC. Mea culpa—it was a mistake. At the time, the line that I took—I looked it up—was that area health authorities would sort it all out. Where are area health authorities? They did not, and none of their successors has. I think we need to go back to a system that identifies areas that are overdoctored or underdoctored to consider how we can justify this situation. It cannot be allowed to continue. I know that officials feel that the kind of MPC system we had is not fit for today’s more modern circumstances, but one way or another, either through financial incentives or through some restrictions, we have to do something about this. I hope the Government will be sympathetic.

[Baroness Manzoor (Con)]

Noble Lords will know that I am passionate about improving the health of all. The National Health Service is the National Health Service, not the ill service. So many disadvantaged, marginalised groups are not receiving the care or the health that they need. I will not go back into the disparities and the health inequalities. I have put my name to the amendment from the noble Lord, Lord Patel, who spoke very clearly. It is a simple amendment but would be a pivotal, key amendment to the Bill.

I also support the amendment in the name of the noble Lord, Lord Hunt, because without having the first line of defence of GPs, marginalised groups do not have the access to doctors that they desperately need. Everybody knows the effects of inequalities on the economy, the NHS and individuals. The Government have a great opportunity to enhance the Secretary of State’s power and strengthen it, rather than transfer the current power.

As I indicated earlier, in my region we had a duty to bring down inequalities in a deprived area. I worked closely with Alan Milburn and other Ministers, including the then Prime Minister, Tony Blair. It worked when that key emphasis, monitoring, duty and strategy were put in place. We need a health strategy, as the noble Lord, Lord Patel, indicated. I leave the question on the table for the Government. This is a fantastic opportunity. It is not about all the structural change that we have been talking about; this is about making a real difference to people’s lives and to the health of our nation.